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Administering immunotherapy in the morning seems to matter. Why?

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Re: Administering immunotherapy in the morning seems to matter. Why?

#61
post #54

Earlier quoted context omitted.

It’s not shameful, it’s how evidence based medicine works. One case is interesting but not a basis for changing a protocol by itself. Tons of things could have influenced the outcome and you need a proper study to know that.

Though it could certainly inspire such a study.

Sure, but someone needs to fund, organize, and conduct the study. If you're not at a research hospital it's not as easy for a one off case to generate a study.

Re: Administering immunotherapy in the morning seems to matter. Why?

#63
post #61

Earlier quoted context omitted.

Though it could certainly inspire such a study.

Sure, but someone needs to fund, organize, and conduct the study. If you're not at a research hospital it's not as easy for a one off case to generate a study.

This is a fairly innocuous change the doctor should be organizing on their own to publish a pilot study. In terms of funding very little would be required since you’re just making a small adjustment to when an existing drug regimen is happening which you already isn’t a controlled factor requiring FDA oversight or anything.

Re: Administering immunotherapy in the morning seems to matter. Why?

#64
post #55
post #50

Earlier quoted context omitted.

Amazing. And shameful (for them.)

> And shameful (for them.) 1. A single positive outcome with N=1 should generally not be the basis for making a medical recommendation. 2. It takes a mountain of research work to go from that to a study that you can draw meaningful conclusions from. 3. The hospital is not in the business of doing research, it's in the business of treating patients.

I agree n=1 generally isn’t enough, but something like this is easily something you ask for volunteers for as an experiment. There’s 0 risk, you’re taking the same drug. The only reason a given time is selected anyway is for administrative ease not because there’s medical requirements.

Re: Administering immunotherapy in the morning seems to matter. Why?

#65
post #61

Earlier quoted context omitted.

Sure, but someone needs to fund, organize, and conduct the study. If you're not at a research hospital it's not as easy for a one off case to generate a study.

This is a fairly innocuous change the doctor should be organizing on their own to publish a pilot study. In terms of funding very little would be required since you’re just making a small adjustment to when an existing drug regimen is happening which you already isn’t a controlled factor requiring FDA oversight or anything.

Even simple studies are expensive and difficult. You need IRB approval, data collection and organization, staff to do those things. It seems simple from the outside but making it happen takes time, effort, and money which then means also applying for grants which is a process in and of itself.

Re: Administering immunotherapy in the morning seems to matter. Why?

#67
I wonder if the same would also be true for immunosuppressants administered for autoimmune conditions. Given they mostly interact with the signaling pathways, I guess in theory they should also be more effective in the morning if there is more immune cell activity going on.

Re: Administering immunotherapy in the morning seems to matter. Why?

#68
post #54
post #50

Earlier quoted context omitted.

Amazing. And shameful (for them.)

It’s not shameful, it’s how evidence based medicine works. One case is interesting but not a basis for changing a protocol by itself. Tons of things could have influenced the outcome and you need a proper study to know that.

The razor to use to determine whether something is actually evidenced based under uncertainty is whether you would follow the same policy if it was your own child.

There are many things that are simply uncertain and “untrue until proven otherwise” isn’t an exclusively optimal policy.

Re: Administering immunotherapy in the morning seems to matter. Why?

#69
post #60
post #55

Earlier quoted context omitted.

> And shameful (for them.) 1. A single positive outcome with N=1 should generally not be the basis for making a medical recommendation. 2. It takes a mountain of research work to go from that to a study that you can draw meaningful conclusions from. 3. The hospital is not in the business of doing research, it's in the business of treating patients.

Regarding 3: Shouldn’t the medical system be optimizing for patient outcomes rather than the business their in? Regarding the first two: I think the anecdote being from 1995 suggests there would have been time to put together said mountain of research. I’m not agreeing that this is shameful for the original doctor, but I do think it’s shameful if avenues for potential research are not taken because it’s inconvenient…

Yes, it should.

But cost is also important to patients. Or it would be in any universe that made sense.

Re: Administering immunotherapy in the morning seems to matter. Why?

#70
post #55

Earlier quoted context omitted.

> And shameful (for them.) 1. A single positive outcome with N=1 should generally not be the basis for making a medical recommendation. 2. It takes a mountain of research work to go from that to a study that you can draw meaningful conclusions from. 3. The hospital is not in the business of doing research, it's in the business of treating patients.

I agree n=1 generally isn’t enough, but something like this is easily something you ask for volunteers for as an experiment. There’s 0 risk, you’re taking the same drug. The only reason a given time is selected anyway is for administrative ease not because there’s medical requirements.

Its not easy to ask if it messes with staff scheduling.
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